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ACIP 2011

ACIP 2011

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Latest American recommendations on immunization
Latest American recommendations on immunization

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Published by: Prabir Kumar Chatterjee on Feb 02, 2011
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Continuing Education Examination available athttp://www.cdc.gov/mmwr/cme/conted.html
Recommendations and Reports / Vol. 60 / No. 2 January 28, 2011
General Recommendations on Immunization
Recommendations of the Advisory Committeeon Immunization Practices (ACIP)
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report
 
The
 MMWR 
series o publications is published by the Oice o Surveillance, Epidemiology, and Laboratory Services, Centers or Disease Control and Prevention (CDC),U.S. Department o Health and Human Services, Atlanta, GA 30333.
Suggested Citation:
Centers or Disease Control and Prevention. [Title]. MMWR 2011;60(No. RR-#):[inclusive page numbers].
Centers for Disease Control and Prevention
Thomas R. Frieden, MD, MPH,
Director 
Harold W. Jae, MD, MA,
 Associate Director for Science 
 James W. Stephens, PhD,
Office of the Associate Director for Science 
Stephen B. Thacker, MD, MSc,
Deputy Director for Surveillance, Epidemiology, and Laboratory Services 
Stephanie Zaza, MD, MPH,
Director, Epidemiology and Analysis Program Office 
MMWR Editorial and Production Staff 
Ronald L. Moolenaar, MD, MPH,
Editor,
MMWR 
Series 
Christine G. Casey, MD,
Deputy Editor,
MMWR 
Series 
Teresa F. Rutledge,
 Managing Editor,
MMWR 
Series 
David C. Johnson,
Lead Technical Writer-Editor 
Catherine B. Lansdowne, MS,
Project Editor 
Martha F. Boyd,
Lead Visual Information Specialist 
Malbea A. LaPete, Julia C. Martinroe,Stephen R. Spriggs, Terraye M. Starr
Visual Information Specialists 
Quang M. Doan, MBA, Phyllis H. King
Information Technology Specialists 
MMWR Editorial Board
 William L. Roper, MD, MPH, Chapel Hill, NC, ChairmanVirginia A. Caine, MD, Indianapolis, IN Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA David W. Fleming, MD, Seattle, WA  William E. Halperin, MD, DrPH, MPH, Newark, NJKing K. Holmes, MD, PhD, Seattle, WA Deborah Holtzman, PhD, Atlanta, GA  John K. Iglehart, Bethesda, MDDennis G. Maki, MD, Madison, WIPatricia Quinlisk, MD, MPH, Des Moines, IA Patrick L. Remington, MD, MPH, Madison, WIBarbara K. Rimer, DrPH, Chapel Hill, NC John V. Rullan, MD, MPH, San Juan, PR  William Schaner, MD, Nashville, TN Anne Schuchat, MD, Atlanta, GA Dixie E. Snider, MD, MPH, Atlanta, GA  John W. Ward, MD, Atlanta, GA 
Disclosure of Relationship
CDC, our planners, and our content experts wish to disclose that they have no inancialinterests or other relationships with the manuacturers o commercial products, sup-pliers o commercial services, or commercial supporters. This report will not includeany discussion o the unlabeled use o a product or a product under investigationaluse with the exception o the ollowing situations:1. The nonsimultaneous administration o yellow ever (YF) vaccine and inactivatedvaccines.2. Simultaneous administration o an inactivated and live vaccine (e.g., pneumococcalpolysaccharide vaccine [PPSV] and zoster [Zos] vaccine).3. Interchangeability o combination vaccines and single-component vaccines (e.g.,using single-component
Haemophilus influenzae 
type b [Hib], diphtheria andtetanus toxoids and acellular pertussis (DTaP), and inactivated poliovirus [IPV]or later doses in series, ater a series has begun with DTaP-IPV/Hib).4. Interchangeability o brands o combination vaccines and single-componentvaccines (e.g., using DTaP-IPV/Hib and single-component hepatitis B [Hep B]vaccine or later doses in series that might have previously included DTaP-IPV-HepB and Hib).5. Rotarix and RotaTeq need not be repeated i an inant spits up or regurgitates a dose.6. Contact allergy to latex is neither a contraindication nor a precaution to the useo quadrivalent meningococcal conjugate vaccine (MCV4) in the absence o ananaphylactic allergy.7. No need to repeat a dose o MCV4 vaccine given subcutaneously.8. Revaccination with MCV4.9. Appropriate storage and handling or the ollowing vaccines at 35°F–46°F:
•DTaP•Hib•HepatitisA•HepatitisB•Humanpapillomavirus(HPV)•PPSV •Measles,mumps,andrubella(MMR)•Pneumococcalconjugatevaccine(PCV)•Rotavirus(RV)•Tetanustoxoid,reduceddiphtheriatoxoid,
and acellular pertussis (Tdap) vaccine
•Trivalentinactivatedinfluenzavaccine(TIV)
10. Initiation o live Zos vaccine in immunocompetent patients 3 months ater remissionrom chemotherapy.11. Avoiding conception or 1 month ater vaccination with MMR or varicella (Var)vaccine.12. A minimum age o 12 months or the ourth dose o DTaP.13. Use o pneumococcal conjugate vaccine and
Haemophilus influenzae 
b vaccine inpersons receiving hematopoietic cell transplant or who are inected with humanimmunodeiciency virus, regardless o age.There is no commercial support or this activity.
Credit:
Constant Joseph Desbordes (1761–1827),
Baron Jean Louis Alibert (1768–1837) performing the vaccination against smallpox in the Château of Liancourt 
(detail)
,
 c. 1820, French. Oil on canvas. Courtesy: Musée de l’Assistance Publique — Hôpitaux de Paris, Paris, France / Archives Charmet / The Bridgeman Art Library.
CONTENTS
Introduction ............................................................................................................3Methods....................................................................................................................4 Timing and Spacing o Immunobiologics ....................................................4Contraindications and Precautions..............................................................10Preventing and Managing Adverse Reactions.........................................11Vaccine Administration ....................................................................................13Storage and Handling o Immunobiologics .............................................17Altered Immunocompetence ........................................................................19Special Situations ...............................................................................................23Vaccination Records ..........................................................................................30Vaccination Programs .......................................................................................31Vaccine Inormation Sources .........................................................................34Acknowledgments .............................................................................................35Reerences .............................................................................................................52Abbreviations ......................................................................................................59Glossary..................................................................................................................60
 
Recommendations and Reports
MMWR / January 28, 2011 / Vol. 60 / No. 2 3
General Recommendations on Immunization
Recommendations of the Advisory Committee on ImmunizationPractices (ACIP)
Prepared by  Andrew T. Kroger, MD
1
Ciro V. Sumaya, MD
2
Larry K. Pickering, MD
1
 William L. Atkinson, MD
1
1
National Center for Immunization and Respiratory Diseases 
 2 
Texas A&M Health Science Center, College Station, Texas 
Summary 
This report is a revision of the 
General Recommendations on Immunization
and updates the 2006 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the AdvisorCommittee on Immunization Practices [ACIP]. MMWR 2006;55[No. RR-15]). The report also includes revised content from previ-ous ACIP recommendations on the following topics: adult vaccination (CDC. Update on adult immunization recommendations of the immunization practices Advisory Committee [ACIP]. MMWR 1991;40[No. RR-12]); the assessment and feedback strategy to increase vaccination rates (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination rates—assessment and feedback of provider-based vaccination coverage information. MMWR 1996;45:219–20); linkage of vaccination services and those of the Supplemental Nutrition Program for Women, Infants, and Children (WIC program) (CDC.Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination coverage by age 2 years—linkage of vaccination and WIC services. MMWR 1996;45:217–8); adolescent immunization (CDC. Immunizationof adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the  American Academy of Family Physicians, and the American Medical Association. MMWR 1996;45[No. RR-13]); and combinationvaccines (CDC. Combination vaccines for childhood immunization: recommendations of the Advisory Committee on ImmunizationPractices [ACIP], the American Academy of Pediatrics [AAP], and the American Academy of Family Physicians [AAFP]. MMWR 1999;48[No. RR-5]).Notable revisions to the 2006 recommendations include 1) revisions to the tables of contraindications and precautions to vaccination,as well as a separate table of conditions that are commonly misperceived as contraindications and precautions; 2) reordering of the report content, with vaccine risk-benefit screening, managing adverse reactions, reporting of adverse events, and the vaccine injury compensation program presented immediately after the discussion of contraindications and precautions; 3) stricter criteria for selecting an appropriate storage unit for vaccines; 4) additional guidance for maintaining the cold chain in the event of unavoidable temperature deviations; and 5) updated revisions for vaccination of patients who have received a hematopoietic cell transplant. The most recent ACIP recommenda-tions for each specific vaccine should be consulted for comprehensive details. This report, ACIP recommendations for each vaccine, and additional information about vaccinations are available from CDC at http://www.cdc.gov/vaccines .
Introduction
CDC recommends routine vaccination to prevent 17vaccine-preventable diseases that occur in inants, children,adolescents, or adults. This report provides inormation orclinicians and other health-care providers about concerns thatcommonly arise when vaccinating persons o various ages.Providers and patients encounter numerous issues, such asthe timing o each dose, screening or contraindications andprecautions, the number o vaccines to be administered, theeducational needs o patients and parents, and interpretingand responding to adverse events. Vaccination providers helppatients understand the substantial, occasionally conlicting,inormation about vaccination. These vaccination recom-mendations are intended or clinicians and other health-careproviders who vaccinate patients.
The material in this report originated in the National Center orImmunization and Respiratory Diseases, Anne Schuchat, MD,Director.
Corresponding preparer:
Andrew Kroger, MD, National Center orImmunization and Respiratory Diseases, 1600 Cliton Rd., MS E-52, Atlanta, GA 30333. Telephone: 404-639-1958; Fax: 404-639-8828;E-mail:aok2@cdc.gov .

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